With Health of the Public Funding, University of Minnesota Evaluates State Health Reform, Amends Its Curriculum

From 1993 to 1997, staff at the University of Minnesota evaluated a state health reform initiative, overhauled the medical school's ambulatory care instruction, and formed a partnership with a local community to identify and address environmental health problems (environment-related diseases and health problems).

The project was part of the Robert Wood Johnson Foundation (RWJF) Health of the Public: An Academic Challenge national program.

Key Results

Working with members of the state Department of Health, project staff documented a decline of almost 40 percent in long-term uninsurance among Minnesota children. The researchers attributed the improvement largely to MinnesotaCare.

The medical school instituted a new required family practice rotation for third-year students and overhauled the required ambulatory care course, conducting half the course in family medicine practices and splitting the rest between pediatrics and internal medicine. The school recruited more than 150 new community preceptors to participate in the course, which focused heavily on population health, prevention and evidence-based medicine. In addition, the environmental health segment (covering environment-related diseases and health problems) was expanded.

In 1996, the schools of medicine and public health formed a partnership with the Frogtown community, a low-income, multiethnic neighborhood in St. Paul, Minn., to identify and address environmental health problems and build capacity to prevent them in the future. The Frogtown partnership has accomplished several tasks:

Conducted a comprehensive educational survey in Frogtown's Vietnamese and English-speaking communities to assess, prioritize and act on community members' environmental health needs and concerns. A similar effort was begun in the Hmong community. The effort:

Free syrup of ipecac (for emergency treatment of poisoning) and lead testing for children.

Encouraged community members to serve as peer teachers.

Provided research, technical assistance and policy advice to the public, community leaders and local government in response to community-wide concerns, which included pollution from a manufacturing plant.

Produced and distributed multilingual educational materials on a dozen environmental health and home safety topics to Vietnamese, Hmong and English-speaking families. Topics included mice and rats, cockroaches, carbon monoxide, asbestos, and lead poisoning.

Published a regular column in the community newspaper to address environmental health issues.

The project director worked with four health maintenance organizations (HMOs) that were experimenting with the notion of combined responsibility for health of a defined population, and had pooled resources to begin providing health services in an inner-city school. A major focus was improving child health status with regard to asthma.

In addition to these accomplishments during the 1991–93 phase, the schools' Health Priorities Project worked with legislators and the state health department to develop, implement and monitor MinnesotaCare, a state-subsidized health insurance program for low-income people, which passed in 1992. The renewal phase, which received additional support from the Allina Foundation, sought to strengthen and expand working partnerships with the state government and the community.